Tag: statistics

J Nerv Ment Dis. 2023 Jun 29. doi: 10.1097/NMD.0000000000001688. Online ahead of print.

ABSTRACT

The association between major depressive disorder (MDD) and personality traits has been extensively studied. However, differences in personality traits between patients with melancholic MDD (MEL) and nonmelancholic MDD (NMEL) remain unclear. In this study, we aimed to determine whether neuroticism, which has been associated with MDD, and the five affective temperament subtypes assessed by the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) can be used to distinguish MEL and NMEL. A total of 106 patients with MDD (MEL, n = 52; NMEL, n = 54) and 212 age- and sex-matched healthy controls answered the Eysenck Personality Questionnaire-revised and the short version of TEMPS-A. In hierarchical logistic regression analysis, only depressive temperament scores were identified as a statistically significant feature distinguishing NMEL from MEL. Depressive temperament scores assessed by the short version of TEMPS-A were found to be significantly higher in NMEL patients than in MEL patients.

PMID:37399577 | DOI:10.1097/NMD.0000000000001688

Psychother Res. 2023 Jul 3:1-12. doi: 10.1080/10503307.2023.2229505. Online ahead of print.

ABSTRACT

OBJECTIVE: The current study aimed to inform the varied and limited research on clinical variables in the context of teletherapy. Questions remain about the comparative quality of therapeutic alliance and clinical outcome in the context of teletherapy compared to in-person treatment.

METHODS: We utilized a cohort design and a noninferiority statistical approach to study a large, matched sample of clients who reported therapeutic alliance as well as psychological distress before every session as part of routine clinical practice at a university counseling center. A cohort of 479 clients undergoing teletherapy after the emergence of the COVID-19 pandemic was compared to a cohort of 479 clients receiving in-person treatment before the onset of the pandemic. Tests of noninferiority were conducted to investigate the absence of meaningful differences between the two modalities of service delivery. Client characteristics were also examined as moderators of the association between modality and alliance or outcome.

RESULTS: Clients receiving teletherapy showed noninferior alliance and clinical outcome when compared to clients receiving in-person psychotherapy. A significant main effect on alliance was found with regard to race and ethnicity. A significant main effect on outcome was found with regard to international student status. Significant interactions on alliance were found between cohort and current financial stress.

CONCLUSIONS: Study findings support the continued use of teletherapy by demonstrating commensurate clinical process and outcome. Yet, it will be important for providers to be aware of existing mental health disparities that continue to accompany psychotherapy – in person and via teletherapy. Results and findings are discussed in terms of research and clinical implications. Future directions for researching teletherapy as a viable treatment delivery method are also discussed.

PMID:37399573 | DOI:10.1080/10503307.2023.2229505

Ann Intern Med. 2023 Jul 4. doi: 10.7326/M23-0788. Online ahead of print.

ABSTRACT

BACKGROUND: Intramuscular cabotegravir (CAB) and rilpivirine (RPV) is the only long-acting antiretroviral therapy (LA-ART) regimen approved for people with HIV (PWH). Long-acting ART holds promise for improving outcomes among populations with barriers to adherence but is only approved for PWH who have virologic suppression with use of oral ART before initiating injectables.

OBJECTIVE: To examine LA-ART in a population of PWH that includes those with viremia.

DESIGN: Observational cohort study.

SETTING: Urban academic safety-net HIV clinic.

PATIENTS: Publicly insured adults living with HIV with and without viral suppression, high rates of unstable housing, mental illness, and substance use.

INTERVENTION: Demonstration project of long-acting injectable CAB-RPV.

MEASUREMENTS: Descriptive statistics summarizing cohort outcomes to date, based on pharmacy team logs and electronic medical record data.

RESULTS: Between June 2021 and November 2022, 133 PWH at the Ward 86 HIV Clinic were started on LA-ART, 76 of whom had virologic suppression while using oral ART and 57 of whom had viremia. The median age was 46 years (IQR, 25 to 68 years); 117 (88%) were cisgender men, 83 (62%) had non-White race, 56 (42%) were experiencing unstable housing or homelessness, and 45 (34%) had substance use. Among those with virologic suppression, 100% (95% CI, 94% to 100%) maintained suppression. Among PWH with viremia, at a median of 33 days, 54 of 57 had viral suppression, 1 showed the expected 2-log₁₀ reduction in HIV RNA level, and 2 experienced early virologic failure. Overall, 97.5% (CI, 89.1% to 99.8%) were projected to achieve virologic suppression by a median of 33 weeks. The current virologic failure rate of 1.5% in the cohort is similar to that across registrational clinical trials at 48 weeks.

LIMITATION: Single-site study.

CONCLUSION: This project demonstrates the ability of LA-ART to achieve virologic suppression among PWH, including those with viremia and challenges to adherence. Further data on the ability of LA-ART to achieve viral suppression in people with barriers to adherence are needed.

PRIMARY FUNDING SOURCE: National Institutes of Health, City and County of San Francisco, and Health Resources and Services Administration.

PMID:37399555 | DOI:10.7326/M23-0788

Ann Intern Med. 2023 Jul 4. doi: 10.7326/M23-0053. Online ahead of print.

ABSTRACT

BACKGROUND: State medical cannabis laws may lead patients with chronic noncancer pain to substitute cannabis in place of prescription opioid or clinical guideline-concordant nonopioid prescription pain medications or procedures.

OBJECTIVE: To assess effects of state medical cannabis laws on receipt of prescription opioids, nonopioid prescription pain medications, and procedures for chronic noncancer pain.

DESIGN: Using data from 12 states that implemented medical cannabis laws and 17 comparison states, augmented synthetic control analyses estimated laws’ effects on receipt of chronic noncancer pain treatment, relative to predicted treatment receipt in the absence of the law.

SETTING: United States, 2010 to 2022.

PARTICIPANTS: 583 820 commercially insured adults with chronic noncancer pain.

MEASUREMENTS: Proportion of patients receiving any opioid prescription, nonopioid prescription pain medication, or procedure for chronic noncancer pain; volume of each treatment type; and mean days’ supply and mean morphine milligram equivalents per day of prescribed opioids, per patient in a given month.

RESULTS: In a given month during the first 3 years of law implementation, medical cannabis laws led to an average difference of 0.05 percentage points (95% CI, -0.12 to 0.21 percentage points), 0.05 percentage points (CI, -0.13 to 0.23 percentage points), and -0.17 percentage points (CI, -0.42 to 0.08 percentage points) in the proportion of patients receiving any opioid prescription, any nonopioid prescription pain medication, or any chronic pain procedure, respectively, relative to what we predict would have happened in that month had the law not been implemented.

LIMITATIONS: This study used a strong nonexperimental design but relies on untestable assumptions involving parallel counterfactual trends. Statistical power is limited by the finite number of states. Results may not generalize to noncommercially insured populations.

CONCLUSION: This study did not identify important effects of medical cannabis laws on receipt of opioid or nonopioid pain treatment among patients with chronic noncancer pain.

PRIMARY FUNDING SOURCE: National Institute on Drug Abuse.

PMID:37399549 | DOI:10.7326/M23-0053

Environ Sci Technol. 2023 Jul 3. doi: 10.1021/acs.est.3c00372. Online ahead of print.

ABSTRACT

CO₂ sorption in physical solvents is one of the promising approaches for carbon capture from highly concentrated CO₂ streams at high pressures. Identifying an efficient solvent and evaluating its solubility data at different operating conditions are highly essential for effective capture, which generally involves expensive and time-consuming experimental procedures. This work presents a machine learning based ultrafast alternative for accurate prediction of CO₂ solubility in physical solvents using their physical, thermodynamic, and structural properties data. First, a database is established with which several linear, nonlinear, and ensemble models were trained through a systematic cross-validation and grid search method and found that kernel ridge regression (KRR) is the optimum model. Second, the descriptors are ranked based on their complete decomposition contributions derived using principal component analysis. Further, optimum key descriptors (KDs) are evaluated through an iterative sequential addition method with the objective of maximizing the prediction accuracy of the reduced order KRR (r-KRR) model. Finally, the study resulted in the r-KRR model with nine KDs exhibiting the highest prediction accuracy with a minimum root-mean-square error (0.0023), mean absolute error (0.0016), and maximum R² (0.999). Also, the validity of the database created and ML models developed is ensured through detailed statistical analysis.

PMID:37399541 | DOI:10.1021/acs.est.3c00372

Retina. 2023 Jun 30. doi: 10.1097/IAE.0000000000003873. Online ahead of print.

ABSTRACT

PURPOSE: The mean change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), and endothelial cell counts (ECD) after intraocular lens (IOL) implantation and the incidence rate of postoperative complications were estimated by systematic review and meta-analysis to assess the surgical and refractive outcomes of the sutureless scleral fixation (SSF) Carlevale IOL.

METHODS: A literature search was conducted using PubMed, Embase, and Scopus. The weighted mean difference (WMD) was used to present the mean change in BCVA, IOP, and ECD after IOL implantation, whereas a proportional meta-analysis was used to estimate the pooled incidence rate of postoperative complications.

RESULTS: In the meta-analysis of thirteen studies involving 550 eyes, the pooled WMD of the mean change in BCVA showed a significant improvement in BCVA in patients who underwent Carlevale IOL implantation (WMD = 0.38, 95% CI: 0.30 to 0.46, p <0.001; heterogeneity (I2) =52.02%). The subgroup analyses indicated that the mean change in BCVA was not significantly higher according to the last follow-up visit, with no statistically significant subgroup effect. (p=0.21). (WMD up to six months: 0.34, 95% CI: 0.23 to 0.45, I2 = 58.32%, WMD up to twenty-four months: 0.42, 95% CI: 0.34 to 0.51, I2 = 38.08 %). In the meta-analysis of sixteen studies involving 608 eyes, the pooled incidence rate of postoperative complications was equal to 0.22 (CI: 0.13-0.32, I2 = 84.87, p ≤ 0.001).

CONCLUSIONS: Carlevale IOL implantation represents a reliable method of restoring vision in eyes with missing capsular or zonular support.

PMID:37399540 | DOI:10.1097/IAE.0000000000003873

Perfusion. 2023 Jul 3:2676591231187957. doi: 10.1177/02676591231187957. Online ahead of print.

ABSTRACT

BACKGROUND: Intermittent Claudication (IC) is exercise pain seen in lower extremity arterial diseases. If it is left untreated, it may be the initial sign of a process leading to amputation. In the present study, the purpose was to compare the postoperative early and mid-term results of the patients who were treated with endovascular methods and those who underwent bypass graft surgery in the treatment due to IC complaints because of isolated Femoropopliteal Arterial Disease.

METHOD: Postoperative first-month, sixth-month, and 12th-month follow-up results, procedure requirements, and demographic characteristics of the 153 patients who underwent femoropopliteal bypass because of isolated Femoropopliteal Arterial Disease and 294 patients who underwent endovascular intervention in our hospital between January 2015 and May 2020 were compared in the study.

RESULTS: It was found in demographic characteristics that endovascular intervention was performed more frequently in smokers and graft bypass surgery was performed more frequently in hyperlipidemic patients, and the results were found to be statistically significant. High amputation rates were detected at statistically significant levels in diabetic and hypertriglycemic patients and 1-year primary patency rates were found to be higher in patients who underwent graft bypass surgery. No differences were detected between the two methods in terms of mortality.

CONCLUSION: Interventional treatment modalities must be considered for patients with isolated Femoropopliteal Arterial Disease whose symptoms persist despite exercise and the best medical treatment. We think that Bypass Graft Surgery has more positive results than endovascular interventions when short and medium-term amputation, repetitive intervention needs, and changes in quality of life are compared in patients who receive the same medical treatment.

PMID:37399504 | DOI:10.1177/02676591231187957

Blood Adv. 2023 Jul 3:bloodadvances.2023010562. doi: 10.1182/bloodadvances.2023010562. Online ahead of print.

ABSTRACT

Major depessive disorder (MDD), bipolar disorder (BD) and schizophrenia (SCZ) are accompanied by an increased risk of cardiovascular diseases including venous thromboembolism (VTE). Reasons for this are complex, and include obesity, smoking and use of hormone and psychotropic medications. Genetic studies increasingly provide evidence of shared genetic risk of psychiatric and cardiometabolic illness. This study aimed to determine whether genetic predisposition to MDD, BD or SCZ was associated with an increased risk of VTE. Genetic correlations using the largest genome-wide genetic meta-analyses summary statistics for MDD, BD and SCZ (Psychiatric Genetics Consortium) and a recent genome-wide genetic meta-analysis of VTE (INVENT consortium) demonstrated a positive association between VTE and MDD but not BD or SCZ. The same summary statistics were used to construct polygenic risk scores for MDD, BD and SCZ in UK Biobank participants of self-reported white British ancestry. These were assessed for impact on self-reported VTE risk (10786 cases, 285124 controls), using logistic regression, in sex-specific and sex-combined analyses. We identified significant positive associations between polygenic risk for MDD and risk of VTE in men, women and sex-combined analyses, independent of known risk factors. Secondary analyses demonstrated that this association was not driven by those with lifetime experience of mental illness. Meta-analyses of individual data from six additional independent cohorts replicated the sex-combined association. This report provides evidence for shared biological mechanisms leading to MDD and VTE, and suggests that, in the absence of genetic data, family history for MDD might be considered when assessing risk of VTE.

PMID:37399490 | DOI:10.1182/bloodadvances.2023010562

Ann Plast Surg. 2023 Jun 1;90(6S Suppl 5):S667-S673. doi: 10.1097/SAP.0000000000003471. Epub 2023 Feb 15.

ABSTRACT

BACKGROUND: As reduction mammoplasty rises in popularity, it will become increasingly important to understand the patient-reported outcome measurements associated with a successful operation. There has been a growing body of literature on BREAST-Q outcomes for patients undergoing reduction mammoplasty, but meta-analyses of patient factors and BREAST-Q Reduction Module scores are lacking. This study sought to ascertain which patient factors were associated with improvements in BREAST-Q scores compared with preoperative levels.

METHODS: A literature review through August 6, 2021, was conducted using the PubMed database to select publications using the BREAST-Q questionnaire to evaluate outcomes after reduction mammoplasty. Studies examining breast reconstruction, breast augmentation, oncoplastic reduction, or breast cancer patients were excluded. BREAST-Q data were stratified by comorbidities, age, body mass index (BMI), complication rate, and resection weight.

RESULTS: Among 14 articles and 1816 patients, the mean age ranged from 15.8 to 55 years, mean BMI ranged from 22.5 to 32.4 kg/m2, and bilateral mean resected weight ranged from 323 to 1845.96 g. Overall complication rate was 19.9%. On average, satisfaction with breasts improved by 52.1 ± 0.9 points (P < 0.0001), psychosocial well-being improved by 43.0 ± 1.0 points (P < 0.0001), sexual well-being improved by 38.2 ± 1.2 points (P < 0.0001), and physical well-being improved by 27.9 ± 0.8 points (P < 0.0001). The mean age was positively correlated with preoperative sexual well-being (Spearman rank correlation coefficient [SRCC]: 0.61, P < 0.05). Body mass index was negatively correlated with preoperative physical well-being (SRCC: -0.78, P < 0.01) and positively correlated with postoperative satisfaction with breasts (SRCC: 0.53, P < 0.05). The mean bilateral resected weight was significantly positively correlated with postoperative satisfaction with breasts (SRCC: 0.61, P < 0.05). No significant correlations were observed between complication rate and preoperative, postoperative, or mean change in BREAST-Q scores.

CONCLUSIONS: Reduction mammoplasty improves patient satisfaction and quality of life as reflected by the BREAST-Q. Although preoperative or postoperative BREAST-Q scores may be individually influenced by age and BMI, these variables demonstrated no statistically significant effect on the average change between these scores. This literature review suggests that reduction mammoplasty delivers high satisfaction across a diverse range of patient populations, and additional prospective cohort or comparative studies gathering robust data on other patient factors would benefit this area of research.

PMID:37399487 | DOI:10.1097/SAP.0000000000003471

Ann Plast Surg. 2023 Jun 1;90(6S Suppl 5):S639-S644. doi: 10.1097/SAP.0000000000003495. Epub 2023 Feb 18.

ABSTRACT

BACKGROUND: Major shifts in health care systems worldwide have occurred because of coronavirus disease 2019 (COVID-19). With nearly half of all Americans now having a history of COVID-19 infection, there is a pressing need to better understand the importance of prior COVID-19 infection as a potential surgical risk factor. The aim of this study was to investigate the impact of a history of prior COVID-19 infection on patient outcomes after autologous breast reconstruction.

METHODS: We performed a retrospective study using the TriNetX research database, which contains deidentified patient records from 58 participating international health care organizations. All patients who underwent autologous breast reconstruction between March 1, 2020, and April 9, 2022, were included and were grouped based on history of a prior COVID-19 infection. Demographic, preoperative risk factors, and 90-day postoperative complication data were compared. Data were analyzed by propensity score-matched analysis on TriNetX. Statistical analyses were performed by Fisher exact, χ2, and Mann-Whitney U tests as appropriate. Significance was set at P values of <0.05.

RESULTS: Patients with a history of autologous breast reconstruction within our temporal study window (N = 3215) were divided into groups with (n = 281) and without (n = 3603) a prior COVID-19 diagnosis. Nonmatched patients with prior COVID-19 had increased rates of select 90-day postoperative complications, including wound dehiscence, contour deformities, thrombotic events, any surgical site complications, and any complications overall. Use of anticoagulant, antimicrobial, and opioid medications was also found to be higher in those with prior COVID-19.After performing propensity-score matching, each cohort consisted of 281 patients without statistically significant differences between any baseline characteristics. When comparing outcomes between matched cohorts, patients with a history of COVID-19 had increased rates of wound dehiscence (odds ratio [OR], 1.90; P = 0.030), thrombotic events (OR, 2.83; P = 0.0031), and any complications (OR, 1.52; P = 0.037).

CONCLUSIONS: Our results suggest that prior COVID-19 infection is a significant risk factor for adverse outcomes after autologous breast reconstruction. Patients with a history of COVID-19 have 183% higher odds of postoperative thromboembolic events, warranting careful patient selection and postoperative management.

PMID:37399486 | DOI:10.1097/SAP.0000000000003495